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NEUROLOGY 2006;67:700-702
© 2006 American Academy of Neurology
Brief Communications

Outcome in hyperglycemic stroke with ultrasound-augmented thrombolytic therapy

S. R. Martini, MD, PhD, M. D. Hill, MD, A. V. Alexandrov, MD, C. A. Molina, MD and T. A. Kent, MD

From the Department of Neurology, Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center Stroke Program, Houston, TX (S.R.M., T.A.K.); Departments of Clinical Neurosciences, Community Health Sciences and Medicine, University of Calgary, Calgary, Alberta, Canada (M.D.H.); Stroke Treatment Team, University of Texas-Houston Medical School Houston, TX (A.V.A.); and The Neurovascular Unit, Vall d’Hebron Hospital, Barcelona, Spain (C.A.M.). A.V.A. is currently with the Departments of Neurology and Radiology, Barrow Neurological Institute, Phoenix, AZ.

Address correspondence and reprint requests to Dr. Thomas A. Kent, Department of Neurology, Baylor College of Medicine, 2002 Holcombe Blvd., Room 2B223, Houston, TX 77030; e-mail: tkent{at}bcm.tmc.edu

Hyperglycemia independently predicts poor outcome after acute ischemic stroke. CLOTBUST (Combined Lysis Of Thrombus in Brain ischemia using transcranial Ultrasound and Systemic tPA) demonstrated that ultrasound-augmented thrombolysis improves recanalization and 24-hour outcome in patients with acute ischemic stroke. We hypothesized that ultrasound would preferentially benefit hyperglycemic patients, and reviewed CLOTBUST with respect to admission glucose and good outcome. We found that ultrasound’s benefit on 90-day outcome was primarily apparent at higher glucose levels, suggesting that ultrasound therapy may improve outcome following hyperglycemic stroke.

Supported by grants from the National Institute of Neurological Disorders and Stroke (1K23NS02229-01 and 1P50NS044227). Canadian sites were supported by the Canadian Institutes of Health Research and the Alberta Heritage Foundation for Medical Research. The CLOTBUST trial is an investigator-sponsored trial (protocol A2207s, Genentech) and is exempt from the Investigational New Drug status by the Food and Drug Administration. Spencer Technologies, Seattle, provided power-motion Doppler units at no charge and technical support for all participating study sites. DWL, Multigon, and Nicolet also provided portable equipment to hospitals in Houston at no charge. Funding sources played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the manuscript for publication.

Disclosures: Dr. Alexandrov has served as a consultant to Sanofi-Synthelabo and Bristol-Myers Squibb and has received lecture fees from Boehringer Ingelheim and grant support from Genentech. A U.S. patent, "Therapeutic Method and Apparatus for Sonication to Enhance Perfusion Tissue" (no. 6733450), for which Dr. Alexandrov is a coinventor, was issued in May 2004; the patent is owned by the University of Texas. Dr. Hill has served as a consultant to Novo Nordisk and has received lecture fees from Sanofi-Synthelabo and grant support from Ono Pharmaceuticals. Drs. Martini, Molina, and Kent have no conflicts to disclose.

Received December 16, 2005. Accepted in final form April 11, 2006.




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